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Sunday, May 18, 2014  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
The past few years have been associated with significant change in the industry (the contact lens and ophthalmic industry) as we know it. There have been mergers and acquisitions—the effect of which in my opinion will reduce competition, and slow research and development. There have been changes in the regulatory climate with regard to how practitioners and industry interact with each other. While transparency is good, I find that this regulatory climate actually hurts many otherwise excellent clinical, educational, and research programs that fill a very important need in advancing clinical knowledge and ultimate care of the patient. While change is often considered a good thing, I question some of this change in terms of its ultimate impact on our professional lives, and more important, our care of patients.

Allergan Board Unanimously Rejects Unsolicited Proposal from Valeant
The Allergan, Inc. Board of Directors has unanimously rejected the unsolicited proposal announced by Valeant Pharmaceuticals International, Inc. on April 22, 2014. According to the Company, after a comprehensive review, conducted in consultation with its financial and legal advisors, the Allergan Board concluded that the proposal substantially undervalues Allergan, creates significant risks and uncertainties for the stockholders of Allergan, and is not in the best interests of the Company and its stockholders.

The Company also announced that, given the strength in its business, Allergan expects to increase earnings per share by 20 to 25 percent and continue to generate double digit revenue growth in 2015. Additionally, the Company expects to produce double digit sales growth and produce earnings per share compounded annual growth of 20 percent over the next five years.

On May 12, 2014, Allergan’s Chairman and Chief Executive Officer, David Pyott, sent a letter to Valeant's Chairman and CEO, Michael Pearson. The text of that letter and the remainder of Allergan’s announcement can be found here:

On May 13 Valeant issued a response indicating that Valeant intends to improve their offer and remains “resolute in consummating a merger with Allergan.” Valeant plans a webcast on May 28th at 8am EDT to discuss their proposal. Further details including a copy of the Valeant open letter to Allergan stockholders can be found here:

Charissa Lee Named Director, Education, J&J Vision Care, North America

Johnson & Johnson Vision Care, Inc., announced the appointment of Charissa Lee, OD to the role of Director, Education, Johnson & Johnson Vision Care, Inc., North America (JJVCI). In this role, Dr. Lee will lead the development of programs supporting the schools and colleges of optometry across the United States.

A graduate of State University of New York, State College of Optometry, Dr. Lee brings over 12 years of hospital-based and private practice optometry experience to her new position, including providing patient care in diverse settings ranging from a Veterans Administration hospital to a tertiary eyecare clinic in the city of Hangzhou in eastern China. In 2007, she opened her own private practice in Irvine, CA.

Prior to joining JJVCI, Dr. Lee served as a Professional Affairs Consultant to the company, where she regularly educated optometric practitioners on clinical issues and practice management strategies across the country. Since 2012, she has served as Program Director and lecturer for educational events at The Vision Care Institute, LLC.

OPRI to Collaborate with WUHS on Development of Anti-Microbial CL Materials
Optical Polymer Research Inc. (OPRI), located in Mesa, AZ, announces a new collaboration with researchers from Western University of Health Sciences (WUHS), College of Optometry in Pomona, CA to develop a new generation of anti-microbial contact lens materials. These materials are characterized by a composite structure which combines OPRI’s Aquaperm SiOH silicone hydrogel material with an array of especially designed nanoparticles. According to the company, in previous stand-alone experiments the nanoparticles demonstrated potent antimicrobial properties while being biocompatible to the human corneal tissue. The findings of this project may lead to the development of an entire new generation of contact lenses which possess a broad spectrum of antimicrobial properties, and therefore have a wide range of prophylactic and therapeutic uses.

OPRI intends to further expand this research to include its new Operm HDK (Dk 100) fluorosilicone acrylate polymer for those situations when a GP lens is the best choice.

For more information on the company and its products, visit

Post-Graft Fit
Davide Brambilla, DipOptom, Milan, Italy

This post graft case was fitted with a mini scleral lens to improve the comfort and maximize the visual acuity. The cornea presented an elevated astigmatism, more than 8.50 dioptor, and the tilted graft did not allow the eye to be fit with a GP corneal lens without decentralization. In this photo we see just a little blanching on the vascular plexus, not so important after ten hours of wearing.

We thank Davide Brambilla for this image and we welcome photo submissions from our other readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today. Simply visit to upload your image. Please include an explanation of the photo and your full name, degree or title and city/state/country.

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Katherine M. Mastrota, MS, OD, FAAO
Obstructive Sleep Apnea Hypopnea Syndrome and FES
Floppy Eyelid Syndrome is a particular interest of mine. Patients with FES have a number of ocular findings besides those of the ocular surface. One of my key clinical clues to identifying patients with FES is the presence of eyelash ptosis, easily recognizable, but often under appreciated. A common important co-morbidity of FES is obstructive sleep apnea hypopnea syndrome (OSAHS). Many OSAHS patients benefit from the use of a positive airway pressure (PAP) apparatus during sleep.

Just in, an encouraging study from the Canadian Journal of Ophthalmology that investigated the effects of 18 months of PAP treatment on fifty-one patients with OSAHS. The pre- and post-PAP values for eye examination scores (presence of floppy eyelid syndrome, results of the Ocular Surface Disease Index questionnaire, Schirmer I test, tear film break-up time values, and corneal staining stages) were compared. OSAHS is associated with low Schirmer and TBUT values, and high scores in OSDI questionnaire, and high corneal staining stage. The study concludes that appropriate PAP therapy helps to relieve both the systemic findings and the ocular surface problems most likely by providing a return to normal sleep patterns. The authors suggest that long-term (at least 1 year) use of PAP improves the clinical picture of FES and can overcome the problem of ocular irritation that is encountered in the early stage of PAP.

Acar M, Firat H, Yuceege M, Ardic S. Long-term effects of PAP on ocular surface in obstructive sleep apnea syndrome. Can J Ophthalmol. 2014 Apr;49(2):217-21.

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Susan J. Gromacki, OD, MS, FAAO

The TFOS International Workshop on Contact Lens Discomfort
In my last three columns, I discussed using case history at the contact lens follow-up visit to assess lens-wearing success and detect the issues that can eventually lead to contact lens dropout. One such issue is contact lens discomfort.

Recently, a workshop was conducted by the Tear Film & Ocular Surface Society (TFOS) to characterize and define the condition and understand its epidemiology, pathophysiology, diagnosis, and management.1 The authors define contact lens discomfort as, “a condition characterized by episodic or persistent adverse ocular sensations related to lens wear, either with or without visual disturbance, resulting from reduced compatibility between the contact lens and the ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear.”

During the workshop, a subcommittee studied the impact of contact lens material, design, and care on contact lens discomfort.2 It found that although there are few peer-reviewed publications on these topics, clinical practice has indicated that making changes to the lens material, design, care system, and/or replacement schedule can improve comfort. They also note that laboratory and academic studies on this topic may have their limits, since the results from well-controlled groups may not translate to actual patients who are using the lenses and care products non-compliantly. Expect more research on this topic in the future, as there is a paucity of information in the peer-reviewed literature.

1. Nichols JJ, Willcox MDP, Bron AJ et al. The TFOS International Workshop on Contact Lens Discomfort: Executive Summary. Invest Ophthalmol Vis Sci. 2013 54:TFOS7-TFOS13.
2. Jones L, Brennan NA, González-Méijome J, Lally J, Maldonado-Codina C, Schmidt TA, Subbaraman L, Young G, Nichols JJ. The TFOS International Workshop on Contact Lens Discomfort: Report of the Contact Lens Materials, Design, and Care Subcommittee. Invest Ophthalmol Vis Sci. 2013 54:TFOS37-TFOS70.

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Influence of Contact Lens Power Profile on Peripheral Refractive Error

The purpose of this study was to measure the power profile across the optic zone (OZ) of four commercially available soft contact lenses and establish the impact on the peripheral refractive error of the eye.

The power profiles of a spherical conventional hydrogel contact lens (etafilcon A, J&J Vistakon, Jacksonville, FL USA) and three spherical silicone hydrogel contact lenses (lotrafilcon A and B, CIBA Vision, Duluth, GA USA; enfilcon A, CooperVision, Pleasanton, CA USA) with a labeled power of -3.00 and -6.00 diopters were measured using a Shack-Hartmann wavefront sensor power mapping device. Central and peripheral refraction across the horizontal meridian (nasal and temporal visual field at 20, 30, and 40 degrees) was measured with an open-field autorefractor (Shin Nippon NVision K5001, Osaka Japan) with and without contact lenses in 26 myopic subjects. The relative peripheral refractive error on the eye was estimated and compared with and without contact lenses and between contact lenses.

Differences in the distribution of the power profile across the OZ were apparent between contact lens types and powers. No significant differences (p > 0.05) were found between contact lens types for their effect on on-axis refraction. Significant differences (p < 0.05) were found at all peripheral retinal eccentricities between contact lens types.

The researchers concluded that, for a given central power, the four contact lenses exhibited variations in optical power across the OZ of the lens. The distribution of optical power across the OZ has an influence on the peripheral refractive error of the eye.

de la Jara PL, Sankaridurg P, Ehrmann K, Holden BA. Influence of Contact Lens Power Profile on Peripheral Refractive Error. Optom Vis Sci. 2014 May 7. [Epub ahead of print]

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